MEDICARE: MR. PRASAD VRK CHALASANI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	ME0072976	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	060053466	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2071408	OTHER	AETNA HMO
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760477269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PRASAD VRK CHALASANI MD

Provider Business Mailing Address
First Line	:	1900 NEBRASKA AVENUE
Second Line	:	SUITE 9
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4837
Country	:	US
Telephone Number	:	772-465-4499
Fax Number	:	772-466-0832

Provider Business Practice Location Address
First Line	:	1900 NEBRASKA AVENUE
Second Line	:	SUITE 9
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4837
Country	:	US
Telephone Number	:	772-465-4499
Fax Number	:	772-466-0832

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	07/09/2010

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Directions to “ MR. PRASAD VRK CHALASANI MD” Practice Location

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